MTM (Motivational Interviewing) Questions and Answers Graded A+

MTM (Motivational Interviewing) Questions and Answers Graded A+ ¥ Describe the importance of pharmacists utilizing skilled patient dialogue and motivational interviewing strategies in today's health care environment want patients to understand we are care providers, not just medication dispensers ¥ Demonstrate patient-centered communication strategies to facilitate patient behavior change in Motivational Interviewing: OARS and READS strategies. ¥ Respond effectively when encountering AMBIVALENCE or RESISTANCE to health behavior changes ¥ Demonstrate basic proficiency in using key Motivational Interviewing skills in a patient-pharmacist interaction (LAB SKILLS). what is motivational interviewing for? MI is about helping patients activate their own motivations and skills for making health behavior changes. People skills pharmacists need - Basic psychology and sociology - Communication skills - Interactive dialogue skills - Motivational Interviewing skills What not to do in motivational interviewing - directive monologue - closed-ended questions - practitioner centered - resistance or ambivalence= bad or unmotivated patient - does not discuss value of tx or change in pt - does not discuss pt's understanding of dz - does not discuss pt's understanding of tx - does not discuss pt's assessment of the importance and confidence in change - assumes pt. will follow HCP 3 communication styles in health care directing, following, guiding core communication skills asking, informing, listening Motivational interviewing relies on behavioral therapy. List examples Taking medications Filling and refilling medications Going to medical appointments and testing Monitoring medical conditions Preventative health screenings Diet, exercise, alcohol consumption Describe the behavioral model Information and motivation influence behavior skills which influence behavior change List the stages of change (transtheoretical model) *Precontemplation* (no intention to change, unaware of problem) *Contemplation* (aware of problem and seriously thinking of change, but no commitment) *Preparation* (ready to change in the near future, intending to take action, may have reduced problem behaviors) *Action* (taking a definitive action to change, behavior is overly modified) *Maintenance* (working to consolidate the gains attained during the action stage and preventing relapse) READS *R*oll with resistance *E*xpress empathy *A*void argumentation *D*evelop discrepancy *S*upport self-efficacy OARS-I *O*pen-ended questions (develop an understand of the pt. and elicit change talk) *A*ffirming (value the person and recognize their strengths) *R*eflective listening (check understanding, encouraging, acknowledge what is being said is important) *S*ummarizing *I*nforming and advising (convey guiding knowledge after asking permission to do so) Aspects of reflective listening *Nonverbal listening* (undivided attention, eye contact, mirror pt. except for anger) *Verbal responses* (avoid judgment, agreement or disagreement, avoid "buts" unless you are reflecting the pt's ambivalence) *Forming reflective responses*: (Make a guess about what the patient means and give form to the guess in the form of a statement Subject of the sentence is "you" Often involves offering the patient what might be the next sentence in the patient's thought paragraph, instead of echoing the last one ("Continuing the paragraph") Look at this example: Patient: "I'm getting really discouraged about controlling my diabetes." Provider's THOUGHTS in developing a Reflective Response: I want to say, "I'm sure you'll do fine." But wait! That's not really listening! I want to make suggestions, but that's my righting reflex and I need to understand better first: what's discouraging her? Maybe I can say, "Do you mean that you've been trying hard but your sugar levels are still high?" No wait! That's a question! It shuts down her exploring of her own wisdom. I've got it! . . . . Let's see if this works . . . PRODIVER ALOUD: "You've been trying hard but your sugar levels are still high." PAUSE to let the patient respond. okay And this: Patient: "Quitting smoking is just not something I think I can do right now." Provider's THOUGHTS in developing a Reflective Response: I want to say, "I'm sure you can do it if you try! And it's really important that you quit soon." But wait! That's me wanting to make suggestions, which is my own righting reflex with my own agenda. I need to understand more first. What's really behind the lack of confidence? . . . And does she mean that she does want to quit sometime but not just yet? OK, I've got it! . . . PRODIVER ALOUD: "Quitting smoking is something you want to do at some point, but you see some challenges with accomplishing it soon." PAUSE to let the patient respond and expand. okay Bruce Berger's Model of motivational interviewing The 3 following will lead to HBC (health behavior change) - establish rapport - patient's sense making and stages of change - eliciting change talk What are the 3 prime questions? "What were you told this medicine(s) is for?" "How were you told to take it?" "What were you told to expect?" Give examples of reflective listening statements? "Let me make sure I understand . . ." "So, you're wondering . . ." "It sounds like you are thinking/feeling . . ." "It sounds like your experience has been . . ." T/F pt. can talk themselves into change TRUE T/F the following responses ensure more resistance : "Sure you can. It's not so hard." "Yes, but if you continue smoking, you are going to suffer some major consequences." TRUE, try saying: "Tell me what makes this seems so difficult for you." "What would make you more confident that you could do this?" "What bothers you the most about this?" [FOLLOW-UP] "Is this the only thing holding you up, or are there others?" empathy The objective identification with the affective state of another (not his or her experience) What is an empathetic alternative to the following non-empathetic response? Patient: "I like to smoke because it relaxes me." Non-Empathic response: "Can't you think of something else to relax you?"" "It would be difficult to give up something that is relaxing." [FOLLOW-UP] "Is this the only thing holding you up, or are there others?" Avoid argumentation by avoiding "___" responses "yes, but" responses 2 ways to develop discrepancy 1. Discuss the patient's goals relative to their treatment 2. Ask the patient about the good and less good things (pros and cons) about the changes that are needed and listen carefully for discrepancies self-efficacy A person's belief in his or her ability to carry out and succeed with a specific task Benefits of reviewing past successes Provides clues about their resources, skills, and strengths May inspire patient confidence Benefits of sharing what others do Allows you to turn patient ambivalence into a positive May be helpful in motivating patients Benefits of scaling ("on a scale 1-10, how important is this?", follow up with why do you say this # instead of this #?) Directly assesses motivation and confidence Allows for a dialogue about change Examples of road blocks? Agreeing Approving Disagreeing Reassuring Analyzing Interpreting Persuading Questioning